Effects of mindfulness-based stress reduction combined with narrative nursing on treatment adherence and negative emotions with schizophrenia

Abstract

BACKGROUND

Schizophrenia is a chronic mental disorder, which affects about 0.75% of the global population. Most patients show negative symptoms and cognitive impairment, and often accompanied by anxiety and depression. These persistent negative emotions significantly impair the treatment compliance, functional recovery and quality of life of patients. Although mindfulness-based stress reduction (MBSR) and narrative nursing have shown individual efficacy, the combined effect of MBSR and narrative nursing on treatment compliance and negative emotions in patients with schizophrenia is still insufficient. We hypothesized that integrating these methods would synergistically improve the prognosis of patients.

AIM

To investigate the intervention outcomes of MBSR and narrative nursing on treatment adherence and negative emotions in schizophrenia.

METHODS

Clinical records of 120 patients with schizophrenia in Shenyang Mental Health Center from April 1, 2025 to August 31, 2025 were collected in a retrospective manner. Patients were split into a control group (n = 60, receiving usual care) and an observation group (n = 60, receiving MBSR combined with narrative nursing care). Changes in Medication Adherence Rating Scale, Hamilton anxiety scale, Hamilton depression scale, Brief Psychiatric Rating Scale, and Schizophrenia Quality of Life Scale between the two groups were comparable before and after the treatment.

RESULTS

Before intervention, no significant between-group differences were observed (P > 0.05). After 8 weeks, the observation group showed significantly higher Medication Adherence Rating Scale score (8.54 ± 0.83 vs 7.20 ± 0.85, P < 0.05) and greater treatment compliance vs controls (P < 0.001). The Hamilton anxiety scale score (8.34 ± 1.74 vs 10.23 ± 1.67), Hamilton depression scale score (10.85 ± 1.87 vs 12.38 ± 2.23), and Brief Psychiatric Rating Scale score (26.44 ± 1.35 vs 32.32 ± 2.07) of the observation group were all remarkably lower than the control group (all P < 0.001) prompting the improvement in negative emotions and psychiatric symptoms were more favorable. Furthermore, the total Schizophrenia Quality of Life Scale score and scores on each aspect were substantially lower for the observation group than for the control group (all P < 0.001), the improvement in life quality is more obvious.

CONCLUSION

BMSR with narrative nursing significantly improves treatment adherence, alleviates negative emotions and psychiatric symptoms, and enhances quality of life in schizophrenia patients, demonstrating strong clinical value.

Key Words: Schizophrenia; Narrative nursing; Mindfulness-based stress reduction; Treatment adherence; Anxiety; Depression

Core Tip: This retrospective study demonstrates that an 8-week integrated intervention combining mindfulness-based stress reduction with narrative nursing significantly improves treatment adherence, reduces anxiety and depression, alleviates overall psychiatric symptoms, and enhances quality of life in patients with stable schizophrenia, compared to routine care alone. It offers a feasible and comprehensive nursing approach for clinical management of schizophrenia, with significant application value.

INTRODUCTION

Schizophrenia is a common, severe, and usually chronic mental illness affecting about 0.75% of the world’s population, and characterized by multidimensional dysfunction in thoughts, perception, emotion, and behavior[1]. Despite the continuous progress in treatment options centered on antipsychotic drugs, the long-term prognosis of patients still faces serious challenges. Poor treatment adherence and negative emotions are two key factors leading to relapse, worsening of functional impairment, and low quality of life[2,3]. Studies have shown that anxiety and depression are extremely common in the schizophrenia spectrum. Studies have revealed that about one-third of patients with schizophrenia are diagnosed with major depressive disorder[4], and more than 40% of hospitalized schizophrenia patients are diagnosed with comorbid anxiety disorder[5]. At the same time, the long-term medication non-adherence rate of schizophrenia patients is as large as 40%-60%, and non-adherence can lead to suicidal tendencies, decreased quality of life, and persistent relapse of psychotic symptoms[6].

In recent years, mindfulness-based stress reduction (MBSR) and narrative nursing have become emerging psychological intervention models and have received widespread attention in the rehabilitation of mental illnesses. Studies have shown that MBSR can help patients with schizophrenia reduce their anxiety and depression levels and may indirectly affect their treatment attitude[7]. However, mindfulness training mainly acts on the internal experience of patients, lacking the intervention of stigma and self-identity rooted in social and cultural background, and its effect may be limited. Narrative nursing, on the other hand, helps patients separate their “illness” from their “self” by “listening to, deconstructing and reconstructing” their illness stories, thereby reducing stigma and enhancing their confidence in treatment[8]. But the narrative process itself may arouse the patient’s painful memories, which requires the patient to have a certain emotional stability. Based on this, the joint intervention of mindfulness decompression therapy and narrative nursing may have a synergistic effect. The awareness and acceptance ability cultivated by mindfulness training can provide a stable internal psychological space for patients, so that they can observe more calmly when facing the painful experience touched in narrative nursing. Narrative nursing can help patients to transform the calm experience gained in mindfulness practice into a new cognition of self and disease, so as to jointly promote rehabilitation at the two levels of emotional acceptance and cognitive reconstruction. Although studies have confirmed the effectiveness of the two interventions separately, research on their combined application and synergistic effects on treatment adherence and negative emotions in patients with schizophrenia is still lacking.

The goal of this study was to make a retroactive analysis to tentatively discuss the effects of combined MBSR therapy and narrative nursing on treatment adherence, anxious and depressive, mental syndromes, and quality of life in patients with stable schizophrenia, in an effort to inform a reference for the clinical development and promotion of more effective comprehensive psychological nursing programs.

MATERIALS AND METHODS

Research object

Clinical data of 120 patients diagnosed with schizophrenia in Shenyang Mental Health Center from April 1, 2025 to August 31, 2025 were retrospectively collected.

Exclusion and inclusion criteria

Inclusion criteria: (1) Fulfills the diagnostic criterion for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders (5^th Edition)[9]; (2) Age 18-60 years; (3) Stable condition with a total score of < 60 on the Positive and Negative Syndrome Scale (PANSS)[10]; (4) No major adjustments to the medication regimen in the past 4 weeks; and (5) Complete clinical data, including intervention plan, follow-up records and relevant scale assessment data.

Exclusion criteria: (1) Severe failure of major organs such as heart, liver, and kidney; (2) Cognitive disability, unable to cooperate in completing scale assessment and intervention; (3) Other mental illnesses, such as bipolar disorder and depression; and (4) Participants in other systematic psychotherapy research at the same time.

Based on the above criteria, a totally of 120 patients were included, including 60 patients who received routine nursing as the control group, and 60 patients who voluntarily received mindfulness decompression combined with narrative nursing on the basis of routine nursing as the observation group.

Control group

The routine psychiatric nursing intervention was adopted, and the intervention period was 8 weeks. Specific measures included: (1) Basic nursing: Providing a clean and comfortable hospital environment and assisting patients in completing daily activities such as diet, living, and personal hygiene; (2) Disease monitoring: Closely observing the patient’s mental symptoms, sleep and adverse drug reactions, and recording and reporting to the physician in a timely manner; (3) Health education: Explaining the etiology, treatment plan, drug effects and precautions of schizophrenia to patients and their families through group lectures, distribution of brochures and other means; (4) Psychological support: Regularly communicating with patients, listening to their demands, and providing general comfort and encouragement; and (5) Family intervention: Guiding family members to give patients more understanding and companionship, avoiding adverse stimulation, and assisting in supervising patients to take medication on time[11].

Observation group

In conjunction with routine care in the control group, MBSR therapy combined with narrative nursing intervention was implemented for 8 weeks. Specific measures are as follows.

The establishment and training of intervention team: The intervenors were 2 fixed psychiatric specialist nurses. Before the implementation of the intervention, the researchers referred to the previous research literature of mindfulness decompression therapy and narrative nursing, compiled a standardized operation manual, and conducted centralized training and role-playing exercises for the intervenors. The total training duration was 12 class hours. After the theoretical assessment and scenario simulation exercise were qualified, they could participate in the formal intervention, ensuring their consistent understanding of the core technologies of mindfulness decompression and narrative nursing and the homogeneity of operation.

MBSR therapy: Led by the above two intervenors, it combines group intervention with individual guidance and is conducted once a week for 60 minutes each time[12]. Specific content includes: (1) Weeks 1-2: Introduction to mindfulness awareness, explaining the concept, core principles and mechanism of mindfulness, guiding patients to practice the “three-minute breathing space” exercise, and helping patients establish mindfulness awareness; (2) Weeks 3-4: Body scan exercise. Instruct the patient to lie flat and gradually focus on the sensations in different parts of the body, starting from the toes. Accept the discomfort and emotional experience. Each exercise session lasts 20 minutes; (3) Weeks 5-6: Mindfulness meditation and mindfulness walking, guiding patients to focus on their breathing, become aware of unpleasant thoughts and ideas, and encourage them to experience these emotions with an open, curious and accepting attitude – rather than trying to change them. At the same time, they will practice mindfulness walking, focusing on the movement of their feet and the balance of their body; and (4) Weeks 7-8: Mindfulness application and consolidation. Patients are guided to apply mindfulness techniques in daily life, such as mindful eating and mindful communication, to help them cope with stressful events and negative emotions. In addition, mindfulness practice audio is provided, instructing patients to practice at home for 15-20 minutes daily and keep a practice log.

Narrative nursing: It is carried out in conjunction with MBSR therapy, once a week for 45 minutes each time, and is performed by the same psychological nurse[13]. The specific steps include: (1) Goal explanation and relationship building: At the beginning of the intervention, explain the goals of narrative nursing to the patient and assess their emotional state. Nurses build a trusting relationship with patients through positive, non-judgmental listening, encourage their participation, and pay attention to their socio-cultural background and nonverbal behavior; (2) Story collection and listening: Open-ended questions guide patients to recount their illness experiences, including symptom experiences, treatment feelings, family relationships, and inner struggles. Nurses listen attentively throughout, without interrupting or judging; (3) Story analysis and deconstruction: Helping patients analyze key events and emotional moments in their narratives. Detailed deconstructing their illness story, paying attention to socio-cultural factors, responding with empathy, and identifying obstacles and resources within it; (4) Externalizing the problem: Using personification or metaphor techniques (such as calling hallucinations “noisy broadcasts” or referring to the disease as “it”), guide patients to separate “symptoms” or “disease” from “self” to reduce stigma and confusion about self-identity; (5) Explore exceptions and positive resources: Work with patients to explore the strength, wisdom, and “exceptional moments” (flashpoints) in their coping with the disease, where symptoms do not dominate their lives, such as successful emotional regulation or stable social interactions; (6) Story reconstruction: Based on the discovered “exceptions” and intrinsic resources, assist patients in reinterpreting their illness experience, exploring the growth and insights within, and constructing an alternative story that emphasizes resilience, strength, and hope; (7) Action guidelines: Based on the reconstructed new story, work with the patient to develop personalized rehabilitation goals and action plans (such as medication management and social activities); and (8) Support and vision: Provide ongoing emotional support and recognition throughout the patient’s treatment process to enhance their self-efficacy. Ultimately, guide the patient to envision a future that transcends illness and brings better health and well-being.

Considering the retrospective design of this study, the above standardized process of intervention measures is derived from the established clinical nursing pathway and operation manual of the Department. According to the retrospective statistics of nursing records and work logs, the average number of mindfulness decompression group intervention in the observation group was 7.2 ± 0.8, about 60 minutes each time. The average number of completed narrative nursing individual interviews was 7.1 ± 0.9 times, about 45 minutes each time. A very small number of patients failed to complete all eight interventions due to factors such as disease fluctuation or discharge, but the data analysis still followed the principle of intention analysis to include them in the observation group, so as to ensure that the research results are closer to the real world clinical practice.

Observation indicators

Treatment adherence: The Medication Adherence Rating Scale (MARS) was utilized for assessment[14]. The scale has 10 items, each with a score of 0-1, with a total scale of 0-10. It covers medication behavior (such as whether a dose is missed), attitudes toward medication (such as whether the medication is addictive or helps stabilize emotions), and views on medication side effects. Total score ≥ 8 points indicates complete compliance, 6-7 points indicates partial compliance, and < a score of 6 indicates non-compliance. Compliance level was calculated by summing the scores from 0 (poor compliance) to 10 (good compliance), with greater scores indicating superior adherence. Assays were administered pre-intervention and 8 weeks post-intervention.

Negative emotions: (1) Anxiety symptoms: The Hamilton anxiety scale (HAMA) assessment was used, with a total of 14 items[15,16]. A 0-4 point 5-point rating scale was used. A total score ≥ 14 denotes the existence of definite anxiety, and the greater the score, the more acute the anxiety symptoms; and (2) Depressive symptoms: The Hamilton depression scale (HAMD) assessment was used, consisting of 24 items, using a 0-4 point 5-point rating scale. A total score of ≥ 17 denotes the presence of definite depression, and the greater the score, the more serious the depressed feelings. The assessment was conducted before the intervention and 8 weeks after the intervention.

Severity of mental symptoms: The Brief Psychiatric Rating Scale (BPRS) was utilized for assessment[17]. The scale has 18 elements, each of which is graded on a scale from 1 to 7, for a total scale of 18 to 126. The higher the score, the more acute the mental symptoms. The assessment was performed pre- and 8 weeks post-intervention.

Quality of life: The Schizophrenia Quality of Life Scale (SQLS) was utilized for assessment[18]. This scale is specific to schizophrenia and contains 30 items covering psychosocial, motivation and energy, and symptom/side effects dimensions. The average score of each scale was taken, with a score of 0 to 100. The lower the score, the greater the quality of life. The assessment was carried out before and 8 weeks after the intervention.

Statistical analysis

Data was implemented utilizing SPSS 21.0 software. Data were evaluated by mean ± SD, and the t-test was used for intergroup comparisons. Categorical data were displayed as n (%), and χ² tests or Fisher’s exact tests were applied for comparisons between groups. A P < 0.05 was regarded as meaningful statistically.

RESULTS

Comparison of baseline data between the two groups

There were no statistically significant differences in baseline data such as age, sex, body mass index, disease duration, education level, and type of medication taken between the two groups of patients (P > 0.05), indicating comparability (Table 1). The age of the control group was 43.69 ± 11.18 years old, and that of the observation group was 43.02 ± 8.39 years old. In the control group, there were 32 males (53.33%) and 28 females (46.67%), while in the observation group, there were 34 males (56.67%) and 26 females (43.33%); The body mass index of the control group was 22.17 ± 2.05 kg/m², and that of the observation group was 22.22 ± 2.13 kg/m². The course of disease was 3.62 ± 1.55 years in the control group and 3.49 ± 1.46 years in the observation group. In terms of education level, the two groups were mainly junior college or above and technical secondary school or high school. In terms of drug types, atypical antipsychotics were dominant in both groups. There was no significant difference in the above indicators between groups (P > 0.05).

Table 1 Comparison of baseline data between the two groups, n (%)/mean ± SD.

Item	Control group (n = 60)	Observation group (n = 60)	t/χ²	P value
Age (years)	43.69 ± 11.18	43.02 ± 8.39	0.369	0.713
Gender			0.135	0.714
Male	32 (53.33)	34 (56.67)
Female	28 (46.67)	26 (43.33)
Body mass index (kg/m2)	22.17 ± 2.05	22.22 ± 2.13	-0.115	0.909
Disease duration (years)	3.62 ± 1.55	3.49 ± 1.46	0.477	0.634
Educational level			6.000	0.306
Middle school	10 (16.67)	11 (18.33)
Secondary or high school	23 (38.33)	25 (41.67)
College and beyond	27 (45.00)	24 (40.00)
Drug type			0.100	0.752
Atypical antipsychotics	55 (91.67)	56 (93.33)
Typical antipsychotic drugs	5 (8.33)	4 (6.67)

Comparison of treatment adherence between the two groups before and after intervention

Before the interval, there was no clinically relevant difference in MARS scores from the two groups (4.56 ± 0.93 vs 4.66 ± 0.89; t = -0.390, P = 0.697). After 8 weeks of intervention, the MARS scores of the two groups were markedly higher than before the intervention, and the MARS score for the observation group was markedly higher than a control group (7.20 ± 0.85 vs 8.54 ± 0.83; t = -8.680, P < 0.001; Table 2).

Table 2 Comparison of treatment compliance between the two groups, mean ± SD.

Item	Medication Adherence Rating Scale score
	Before intervention	After intervention
Control group (n = 60)	4.56 ± 0.93	7.20 ± 0.85
Observation group (n = 60)	4.66 ± 0.89	8.54 ± 0.83
t value	-0.390	-8.680
P value	0.697	< 0.001

Comparison of negative emotion scores before and after intervention between the two groups

Before the interval, there were no statistically significant variation in HAMA and HAMD scores among the two groups (HAMA: 18.53 ± 2.88 vs 19.41 ± 3.05; t = -1.629, P = 0.106; HAMD: 22.77 ± 3.47 vs 21.90 ± 2.49; t = 1.566, P = 0.120). After 8 weeks of treatment, both HAMA and HAMD scores in both groups were significantly lower than before the treatment, and the HAMA and HAMD scores in the observation group were significantly lower than of the control group (HAMA: 10.23 ± 1.67 vs 8.34 ± 1.74; t = 6.067, P < 0.001; HAMD: 12.38 ± 2.23 vs 10.85 ± 1.87; t = 4.054, P < 0.001; Table 3).

Table 3 Comparison of psychological state indicators before and after intervention in the two groups, mean ± SD.

Item	Hamilton anxiety scale score		Hamilton depression scale score
	Before intervention	After intervention	Before intervention	After intervention
Control group (n = 60)	18.53 ± 2.88	10.23 ± 1.67	22.77 ± 3.47	12.38 ± 2.23
Observation group (n = 60)	19.41 ± 3.05	8.34 ± 1.74	21.90 ± 2.49	10.85 ± 1.87
t value	-1.629	6.067	1.566	4.054
P value	0.106	< 0.001	0.120	< 0.001

Comparison of the severity of mental symptoms before and after intervention between the two groups

Before the interval, there was no clinically relevant difference between the BPRS scores in both groups (42.12 ± 3.67 vs 42.58 ± 3.60; t = -0.689, P = 0.492). After 8 weeks of therapy, the BPRS scores in the two groups were markedly lower than before the intervention, and the BPRS score for the observation group was remarkably lower than the control group (32.32 ± 2.07 vs 26.44 ± 1.35; t = 18.427, P < 0.001; Table 4).

Table 4 Comparison of the severity of mental symptoms between the two groups, mean ± SD.

Item	Brief Psychiatric Rating Scale score
	Before intervention	After intervention
Control group (n = 60)	42.12 ± 3.67	32.32 ± 2.07
Observation group (n = 60)	42.58 ± 3.60	26.44 ± 1.35
t value	-0.689	18.427
P value	0.492	< 0.001

Comparison of quality of life before and after intervention between the two groups

Before the interval, there were no statistically relevant differences in the total SQLS score and scores of each dimension among the two groups (psychosocial score: 30.78 ± 1.93 vs 31.15 ± 1.87; t = -1.201, P = 0.232; motivation and energy: 39.42 ± 3.03 vs 39.58 ± 3.15; t = -0.246, P = 0.806; symptoms/side effects: 23.12 ± 1.51 vs 23.45 ± 1.36; t = -1.275, P = 0.205). After 8 weeks of intervention, the total SQLS score, psychosocial score, motivation and energy score, and symptom/side effect score of both groups were obviously lower than before the intervention, and the above scores in the observation group were significantly lower than control group (psychosocial score: 24.71 ± 2.50 vs 23.58 ± 3.57; t = 15.374, P < 0.001; motivation and energy: 33.22 ± 2.17 vs 30.04 ± 2.97; t = 6.702, P < 0.001; symptoms/side effects: 19.50 ± 1.07 vs 18.73 ± 0.97; t = 4.177, P < 0.001; Table 5).

Table 5 Comparison of quality of life scores before and after intervention between the two groups, mean ± SD.

Item	Psychosocial score		Motivation and energy (scores)		Symptoms/side effects (scores)
	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Control group (n = 60)	30.78 ± 1.93	24.71 ± 2.50	39.42 ± 3.03	33.22 ± 2.17	23.12 ± 1.51	19.50 ± 1.07
Observation group (n = 60)	31.15 ± 1.87	23.58 ± 3.57	39.58 ± 3.15	30.04 ± 2.97	23.45 ± 1.36	18.73 ± 0.97
t value	-1.201	15.374	-0.246	6.702	-1.275	4.177
P value	0.232	< 0.001	0.806	< 0.001	0.205	< 0.001

DISCUSSION

Schizophrenia is a chronically occurring mental illness effecting about 1% of the worldwide community[1]. The diagnostic criterion for the syndrome involves three categories of symptoms: (1) Positive complaints; (2) Negative complaints; and (3) Cognitive disturbances[19]. Patients will experience positive symptoms, which manifest as illusions, paranoia, and impaired thinking, frequently causing assaultive and risky behaviors. A great number of patients additionally undergo continued adverse effects (absence), including language impairment, isolated, emotional and joyful deficits and loss of will. Another category of symptoms is cognitive impairment, which leads to language and functional memory deficits, lengthened time for processing information, deficits in reasoning and concentration. It is reckoned that adverse conditions impact 40% of patients, and significant cognitive impairment covers up to 80%[20]. In recent years, although the use of second-generation antipsychotics has controlled positive symptoms to some extent, residual negative symptoms, cognitive impairment and psychosocial dysfunction are still key issues affecting patient prognosis[21]. Studies have revealed that the non-adherence rate of medication in schizophrenia patients is as large as 63%-74%[22]. Meanwhile, depression, anxieties and drug abuse are common comorbid symptoms of schizophrenia. More than two-thirds of schizophrenia patients experience depressive symptoms, placing them at the greatest risk for schizophrenia comorbid psychosis[23]. Compared to the average population, the incidence of anxiety disorders is increased in schizophrenia patients. Studies have shown that the incidence of anxious disorders among people with schizophrenia is 45.16%[24]. These negative emotions not only exacerbate patients’ subjective suffering and quality of life, but are also closely related to cognitive decline, increased suicide risk and worse long-term prognosis[25,26]. Therefore, exploring effective psychosocial interventions that can simultaneously improve compliance and improve emotional symptoms is essential for promoting the comprehensive recovery of schizophrenia patients.

MBSR therapy has been proven to be efficacious in decreasing stress responses and improving mental health in different populations. Recent studies have shown that mindfulness intervention is effective in treating a variety of mental health disorders and may have effects such as improving psychiatric syndromes and reducing stress in patients with mental illness[27]. At the same time, mindfulness training can reduce cortisol levels, and cortisol is one of the main stress hormones produced by the hypothalamic-pituitary-adrenal axis, thereby reducing chronic stress responses[28]. Narrative nursing therapy is a psychological nursing model that applies the concept of narrative therapy in positive psychology to clinical nursing. Related studies have shown that nurses with narrative abilities can help patients express their emotions by listening to stories and absorbing patients’ inner worries and painful experiences, which helps patients reduce inner pain, cultivate positive emotions, and thus generate a continuous source of upward motivation, which is ultimately beneficial to the prognosis of the disease[29]. In narrative nursing, therapists use skills such as exteriorization, reconstruction and rescripting to help visitors visualize their problems, guide them to rebuild their stories, help them identify new perspectives and attachments, and inspire their inner power to change, enabling them to get rid of their current negative state[30].

Based on this, this study integrates MBSR therapy with narrative nursing to construct a “mindfulness-narrative” joint intervention model. Mindfulness training provides patients with a stable psychological space to observe and accept their inner experiences, while narrative techniques empower them to reintegrate their illness experiences and construct positive meanings. The combination of the two aims to promote recovery through a dual pathway of emotion regulation and cognitive reconstruction.

This study further validated the clinical effectiveness of MBSR combined with narrative nursing by dividing 120 patients with schizophrenia into two groups. Before the interval, there were no remarkable variation in MARS, HAMA, HAMD, BPRS, and SQLS scores between the control and combined groups (P > 0.05), meaning that the baseline data were compared between the two groups, laying the foundation for comparing the subsequent intervention effects. After 8 weeks of intervention, the indexes of the two groups were improved, but the observation group had significant advantages (P < 0.001). The analysis of its mechanism may be that the joint intervention plays a coordinating role in cognitive reconstruction and emotion regulation. In terms of treatment compliance, narrative nursing uses problem externalization technology, such as comparing hallucination experience to noisy external sounds, to promote patients to realize the cognitive separation of disease and self, so as to deconstruct the negative identity of illness, that is, incompetence. On this basis, narrative nursing helps patients reconstruct the alternative narrative that is still in control despite the illness, so that the medication behavior is transformed from passive medical obedience to active self-management strategies. Mindfulness decompression uses body scanning and breath awareness training to improve the patients’ non critical awareness of adverse drug reactions and effectively reduce the drug resistance induced by physical discomfort. The two forms a synergy in the two levels of cognitive signification and physical acceptance, which promotes compliance from behavior obedience to meaning identity. In terms of negative emotions and mental symptoms, the core mechanism of mindfulness decompression is to cultivate a decentralized cognitive perspective. By guiding patients to experience anxiety, depression, hallucinations and other internal experiences as observers, without judgment, involvement, or attempt to eliminate, mindfulness training effectively blocks the vicious circle of fear avoidance caused by symptoms, avoidance aggravating symptoms, and promotes patients to change from being controlled by symptoms to coexisting with symptoms. Narrative nursing, through story deconstruction and rewriting, corrects catastrophic cognition such as recurrence or destruction, reconstructs the disease experience as an opportunity for individual growth, and significantly reduces the sense of control and fear of disease progression in patients. The two cooperate to build a complete emotional regulation chain from awareness, acceptance, reconstruction to transcendence, which has become the key intermediary path for the observation group to be significantly better than the control group in HAMA, HAMD and BPRS scores. In terms of quality of life, narrative nursing assisted patients to identify and externalize the social label of mental patients’ inferiority with the help of social and cultural deconstruction strategy, and reduced the social avoidance tendency induced by discrimination perception. At the same time, the new narrative embedded clear rehabilitation goals and specific action plans, such as medication management and social planning, to provide patients with a clear path of social participation. Mindfulness decompression can transfer mindfulness ability to real social scenes through mindfulness walking, mindfulness communication and other daily training forms, effectively reducing the automatic stress response in interpersonal interaction. Both of them cooperate to intervene from the level of social identity reconstruction and social context adaptation, and jointly improve the subjective evaluation of patients on the dimensions of psychosocial, motivation and energy. The results showed that the combined intervention could not only alleviate the clinical symptoms, but also promote the functional recovery and significance reconstruction in the living state with disease.

In spite of the successful outcome of this study, there are still some limitations. First, this research was a single-center review study in a sample size that was relatively small (120 cases), which may have led to selection bias. Second, all assessment indicators were subjective scales, and biomarkers (such as cortisol and inflammatory factors) were not included as objective indicators, making it impossible to explore the biological mechanisms of the intervention in depth. Third, the intervention effect was only assessed at the end of 8 weeks, lacking medium-term and long-term follow-up with data to confirm the durability of the effect. Fourth, the samples were all from the one center, limiting the applicability of the findings to generalization. Building on the outcomes of this research and existing progress, future research can be carried out in the following directions: (1) Conduct multicenter, large-sample rationalized controlled trials to verify the effectiveness of the combined intervention in patients from different regions and different severity levels; (2) Incorporate indicators such as cortisol and brain functional imaging to clarify the neurobiological mechanisms of the mindfulness-narrative combined intervention; and (3) Conduct long-term follow-up to assess the long-term effects of the combined intervention on relapse rate, readmission rate, and social function.

CONCLUSION

In conclusion, this retrospective analysis preliminarily demonstrates that MBSR combined with narrative nursing can effectively improve treatment adherence in patients with schizophrenia, significantly alleviate anxieties and depression, and improve their life quality, with good safety profiles. Despite limitations, the findings of this research present preliminary indications for the systematic integration of such structured psychosocial interventions into the clinical nursing care of schizophrenia and point to directions for future in-depth research.